Association of Regular Thrombus Surface Phenotype With Complete Recanalization in First-Line Contact Aspiration Thrombectomy for Basilar Artery Occlusion

Objective: To assess whether angiographic thrombus surface phenotype has an impact on efficacy of contact aspiration (CA) thrombectomy in patients with basilar artery occlusion (BAO).Methods: From January 2016 to December 2019, consecutive stroke patients with a BAO and first-line CA were analyzed in this retrospective study. We assessed baseline and imaging characteristics and treatment and clinical outcomes. We rated thrombus surface phenotype on pre-treatment digital subtraction angiography in a three-reader-consensus setting. Primary outcome was complete recanalization (modified treatment in cerebral ischemia [mTICI] 3 and arterial occlusive lesion [AOL] 3) after first-line CA without additionally stent retriever passes. Data analysis was stratified according to thrombus surface phenotype and complete first-line recanalization.Results: Seventy-eight patients met the inclusion criteria. Median age was 74 years (IQR 64–80), 64% were male, and median baseline NIHSS score was 24 (IQR 7–32). Thirty patients had a regular and 16 patients had an irregular thrombus phenotype. Thrombus surface was not assessable in 32 patients. In patients with a regular phenotype, complete recanalization was more often achieved compared to irregular and non-ratable phenotypes (50 vs. 18.8% and 21.9%; p = 0.027). Patients with a regular phenotype [odds ratio [OR] 8.3; 95% confidence interval [CI]: 1.9–35.8; p = 0.005], cardioembolic stroke (OR 12.1, 95% CI: 2.0–72.8; p = 0.007), and proximal end of the thrombus in the middle basilar artery segment (OR 5.2, 95% CI: 1.0–26.6; p = 0.046) were more likely to achieve complete recanalization after first-line CA without rescue therapy.Conclusion: The efficacy of CA may differ according to the angiographic thrombus surface phenotype in patients with BAO. A regular phenotype is associated with higher rates of complete recanalization in first-line CA. However, assessment of thrombus phenotype is frequently not feasible in BAO.

Hyperechogenic intimal lesions and wall thickness of the temporal and facial arteries in elderly patients with arterial occlusions of the eye

ObjectiveTo determine the association of arteriosclerosis, characterised by hyperechogenic intimal lesions (HIL), with wall thickness of the temporal and facial arteries in elderly patients with ocular arterial occlusions.MethodsPatients suffering from non-arteritic ocular perfusion disorders were included. High-resolution compression sonography (18 MHz) images of the temporal arteries (frontal and parietal branch at the upper margin of the auricle) and facial arteries (at the crossing point of the artery over the mandible) were analysed for the presence of HIL (grade 0: absent; grade 1: moderate; grade 2: severe). Characteristics of patients with and without evidence of HIL >grade 1 were compared.ResultsIn total, 330 cranial artery segments of 55 patients were analysed. HIL ≥grade 1 was present in 13.0% of all artery segments and in 38.1% of all patients. Patients with HIL ≥grade 1 in at least one arterial segment displayed significantly increased maximum wall thickness of the temporal arteries (0.62±0.23 mm vs 0.50±0.13 mm; p<0.01) and facial arteries (0.71±0.20 mm vs 0.54±0.19 mm; p=0.01). Patients with at least one temporal or facial artery segment with HIL were older, more often male and more frequently suffered from diabetes mellitus.ConclusionThe presence of HIL goes along with a significantly increased wall thickness of the temporal and facial arteries. These findings should be considered when interpreting the results of sonography of the cranial arteries in the diagnostic workup of suspected giant cell arteritis.

Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

Objectives To evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values. Methods Ninety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype. Results In participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001). Conclusions Abnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced. Key Points • Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis.. • Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced. • Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

Detection and Prediction of Peripheral Arterial Plaque Using Vessel Wall MR in Patients with Diabetes

Objectives. To evaluate the predictive performance of a newly developed delay alternating with nutation for tailored excitation (DANTE) pulse sequence for detecting lower extremity artery wall morphology and distribution in patients with peripheral artery disease (PAD) with diabetes. Methods. Seventy-four PAD patients diagnosed according to 2011 WHO criteria were enrolled, who has diabetic diagnosis by 1999 WHO diabetes criteria. All patients received sequential DANTE, T2WI, DANTE-enhance, and CE-MRA scans. The images consisted of three parts: the iliac artery (segment 1), femoral artery (segment 2), and popliteal artery (segment 3). Regions of interest (ROIs) were drawn on vessels, muscle, and background, and multiple imaging metrics compared between modalities, including image quality score, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). In the images with a score greater than 2, the lumen area (LA), total vessel area (TVA), and vessel thickness (VT) can be identified using semiautomatic image analysis vessel morphology parameters. Results. All 222 arterial segments were successfully analyzed from 71 patients, after exclusion of three subjects with poor image quality ( IQ < 2 ) in segment 3. There were 54 diabetic and 17 nondiabetic patients. Quantitative analysis shows that the CNR difference between diabetic patients and nondiabetic patients was statistically significant for the same segment, while there was no significant difference among the three segments of SNR and CNR. There were a total of 54 diabetics with plaque distribution data, which showed that LA of segments 1 and 2 was higher than that of segment 3. The VWI of segments 1 and 2 was lower than segment 3. Diabetic was associated with vascular WT 3 and WA3, which increased by 0.23 and 0.83 units on average compared without diabetic foot, respectively. Diabetic foot was associated with vascular WT 3, which increased by 0.37 units on average compared without diabetic foot. The incidence of segment 3 plaques was higher than that of segment 1. The incidence of the left and right plaques was different. Conclusions. MR imaging using the DANTE and multicontrast sequence could evaluate plaque morphology, and distribution of lower extremities and the occurrence of diabetic foot development are closely related; it may predict occurrence of PAD with diabetic foot.

The comparison of serum TGF-beta levels and associated polymorphisms in patients with coronary artery ectasia and normal coronary artery

Background Coronary artery ectasia (CAE) is described as the enlargement of a coronary artery segment by 1.5 times or more, which is generally associated with the atherosclerotic process. Atherosclerotic changes lead to arterial remodeling result in CAE. In our study, we measured serum transforming growth factor (TGF)-β1 levels, which have a protective role against atherosclerosis. Further, we aimed to assess the TGF-β1 gene variants rs1800469 (–509C>T, c.−1347C>T) and rs1800470 (c.+29T>C, p.Pro10Leu, rs1982073), which might have an effect on TGF production. Overall, 2877 patients were screened including 56 patients with CAE and 44 patients with normal coronary arteries who were included in the study. Serum TGF-β1 levels were measured using ELISA and compared between two groups. Additionally, TGF-β1 rs1800469 and rs1800470 gene variations were determined using TaqMan® SNP Genotyping Assays. Results Serum TGF-β1 levels were significantly lower in patients with CAE than in controls (p=0.012). However, there was no difference in terms of the genotype and allele distributions of TGF-β1 rs1800469 and rs1800470 polymorphisms. Serum TGF-β1 levels were higher in individuals carrying the TGF-β1 rs1800470 G allele (GG+AG) than in individuals with normal homozygous AA genotype in the CAE group (p=0.012). Conclusion Our findings suggest that lower serum TGF-β1 levels are associated with an increased risk for CAE development and that TGF-β1 polymorphisms exert a protective effect. Furthermore, TGF-β1 rs1800470 G allele carriers were shown to have higher TGF-β1 levels in the CAE group. This suggests that having the G allele in the TGF-β1 rs1800470 polymorphism could prevent CAE development.

Abstract P661: Atheromatous Disease of the Parent Artery is Common in Patients With Lacunar Infarcts

Background: Perforator disease caused by parent artery atheromatous disease is one of the mechanisms implicated in the pathogenesis of lacunar infarcts, but there is limited data on its prevalence. We sought to determine the prevalence of parent vessel atheromatous disease in patients with lacunar infarcts. Methods: This is a retrospective study of consecutive patients with lacunar strokes admitted to NYU Langone Medical Center and Brown University from 2017-2019. Lacunar infarct was defined as subcortical infarct <1.5cm on CT or <2cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. Non-invasive imaging (CTA or MRA) was reviewed by a neuroradiologist or a vascular neurologist to determine the presence or absence of stenosis (< 50%) or luminal irregularity without stenosis in the stem artery segment at the location of the perforator corresponding to the infarct. Patients were divided into two groups: luminal irregularity/stenosis vs. none. We compared clinical and radiographic characteristics and rates of neurological deterioration between the two groups. Results: Among 208 patients with lacunar infarcts (mean age 68.9±11.9 years, 40.9% women, 61.1% White, 13.9% Black, and 12.5% Hispanic), 42 (20.2%) had luminal stenosis and 90 (43.3%) had luminal irregularity without stenosis. Baseline characteristics and prevalence of risk factors were similar between the two groups. Patients with luminal irregularity/stenosis had longer median infarct diameter (10.6 mm vs 8.7 mm, p=0.007). Other imaging variables such as the presence of prior lacunar infarcts and white matter disease burden assessed by Fazekas Score were not significantly different between the two groups. The rate of any neurological deterioration after admission was similar between the two groups (22.7% vs. 15.8%, p=0.283). Conclusion: In this multi-ethnic population, nearly two-thirds of patients with a lacunar infarct were found to have luminal irregularity or stenosis in the parent artery corresponding to the infarct, implying a potential atherosclerotic mechanism. Future studies are needed using advanced imaging of the stem artery to define plaque characteristics which may help determine the underlying mechanism.

Percheron Artery Ischemia: Case Report

Context: The Artery of Percheron (AOP) is an uncommon anatomic vascular variation derivated from posterior cerebral artery segment P1, wich branchs to irrigate bilaterally the thalamus in it is paramedian portion. Amidst vascular cerebral events of the ischemic type, thalamic infarction occour in 11% of the cases. The typical clinical presentation is constituted by the triad: cogniyivebehavior comitente, oculomotors and consience disturbs. Case report: J.F.M.L, 51 years old, male, was found unconscious in his residence by SAMU and then interned in Stroke Room of HGP in 02/06/2020 with a lowered level of consciousness (Glasgow 8). The tests demonstrated a bilateral thalamic infarct due to Artery of Percheron Ischemia. In 02/09/2020 it evolved into a Glasgow 9 being extubated. The CT after 3 days demonstrated absence of bleeding and prophylatically initiated simvastatin, clexane, physiotherapy and phonoaudiology. In 02/15/2020, during physical exam, the pacient was lucid, presented behavior alterations, had left cervical dystonia and ataxia. The patient progressed well and was discharged the next day. Conclusions: The AOP, when occluded, results in bilateral paramedian thalamic and the rostral midbrain infarctions wich may cause diagnosis issues, mainly because of the vast specter of diferential diagnosis. In the presence of triad signals characteritic of bilateral thalamic infarction in CT, it must suspect the manifestation of such entity.

Congenital atresia of the left main coronary artery: management of a 5-year-old child in extremis

Atresia of the left main coronary artery is a rare coronary anomaly. We describe the case of a 5-year-old child presenting in emergency in extremis. Clinical findings of haemodynamic collapse, malignant ventricular tachyarrhythmias and severe mitral regurgitation were indicative of a possible ischaemic aetiology. Surgical revascularization of the atretic left main coronary artery segment using an interposition autologous saphenous vein graft was successfully performed.